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2022-RA-820-ESGO The role of minimally invasive secondary cytoreduction in recurrent ovarian cancer patients
  1. Carmine Conte,
  2. Claudia Marchetti,
  3. Matteo Loverro,
  4. Maria Teresa Giudice,
  5. Andrea Rosati,
  6. Valerio Gallotta,
  7. Giovanni Scambia and
  8. Anna Fagotti
  1. Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy


Introduction/Background Retrospective series have shown minimally invasive secondary cytoreductive surgery (MI-SCS) is a feasible approach in selected cases of recurrent ovarian cancer (ROC). However, no predictors of MI-SCS feasibility are currently available.

This study aims to identify predictive factors of MI-SCS feasibility and to compare perioperative and survival outcomes in a matched series of ROC patients who underwent secondary cytoreduction via an open or minimally invasive surgical approach.

Methodology We retrospectively identified all platinum-sensitive epithelial ROC patients who underwent minimally invasive or laparotomic (LPT) SCS between January 2013 and July 2020. All patients underwent preoperative positron emission tomography computed tomography (PET-CT) scan and diagnostic laparoscopy before SCS. A 1:2 propensity score-matched analysis was performed to balance predictive factors of MI-SCS.

Results Overall, 276 cases were identified (62 MI-SCS and 214 LPT), and a complete gross resection (CGR) was achieved in 262 (94.9%) patients. At multivariate analysis, predictive factors for MI-SCS were NACT (p=0.007), site of recurrence (p=0.031), and number of lesions (p=0.001) (Table).In the propensity-matched population (39 MI-SCS and 78 LPT), CGR was similar for both groups (39 MI-SCS vs 72 LPT; p=0.082). Early post-operative complications were significantly higher in the LPT-SCS (33.3%) than in the MI-SCS (10.3%) group (p=0.004). Only one (2.6%) patient experienced a grade≥3 early post-operative complication in the MI-SCS compared to 13 (16.7%) patients in the LPT cohort (p<0.001).The median follow-up period was 32 months (range18–92) in the propensity-matched population.The median post-recurrence survival (PRS) was 81 months in the MI-SCS group and not reached in the LPT Group (p=0.111).

Abstract 2022-RA-820-ESGO Table 1

Logistic regression for prediction of MI-SCS

Conclusion Patients with single or oligometastatic recurrences can be offered MI-SCS, mainly if localized in the lymph-nodes and/or if they received NACT at primary diagnosis. MI-SCS is associated with favourable perioperative outcomes with no statistically significant differences in terms of PRS with respect to open approach.

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